gentamicin (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL

Intravenous solution

  • 60mg (50mL)
  • 70mg (50mL)
  • 80mg (50mL, 100mL)
  • 90mg (100mL)
  • 100mg (50mL, 100mL)
  • 120mg (100mL)

Susceptible Infections

In underweight and nonobese patients, use of total body weight (TBW) instead of ideal body weight for determining initial mg/kg/dose is accepted; ideal body weight (IBW) also may be used to determine doses for patients who are neither underweight nor obese

Conventional dosing

  • 3-5 mg/kg/day IV/IM divided q8hr  

Extended dosing interval

  • Initial: 5-7 mg/kg/dose IV qDay  
  • Not for use in patients with ascites, burns covering >20% of total body surface area, cystic fibrosis, end-stage renal disease, endocarditis, infants, mycobacterial infections, or pregnancy
  • Measure gentamicin level between 6 and 14 hr after initiating gentamicin infusion; use institution-specific nomogram to determine appropriate dosing interval

Surgical Prophylaxis (Off-label)

5 mg/kg IV as single dose 1 hr prior to surgical incision; alternativley, 1.5 mg/kg IV as single dose for gynecology procedures  

Dose is based on actual body weight (TBW) unless body weight is >20% above ideal body weight (IBW), in which case the dosing weight can be estimated by IBW + 0.4 (TBW - IBW)

Infective Endocarditis Treatment

Enterococcus (native or prosthetic valve); Off-label dose

  • 3 mg/kg/day IV/IM divided q8hr for 4-6 weeks in combination with a beta-lactam and for 6 weeks when administered wiht vancomycin  
  • Organism sensitivity testing should determine choice of concomitant antiibotic and treatment duration

S. aureus (prosthetic valve; methicillin susceptible or resistant); Off-label dose

  • 3 mg/kg/day IV/IM divided q8-12hr for 3-5 days for native valve infections or for 2 weeks for prosthetic valve infections in combination with other antibiotic  
  • Organism sensitivity testing should determine choice of concomitant antibiotic

Viridans group streptococcus and S bovis (native or prosthetic valve); Off-label use

  • 3 mg/kg/day IV/IM qDay (preferred) or divided q8hr for 2 weeks for native or prosthetic valve infections or for 6 weeks for prosthetic valve infections with relatively or fully resistant strains in combination with other antibiotic  
  • Organism sensitivity testing and source of infection should determine choice of concomitant antibiotic

Cystic Fibrosis (Off-label)

7.5-10.5 mg/kg/day IV/IM divided q8hr  

Pelvic Inflammatory Disease (Off-label)

Loading dose: 2 mg/kg IV or IM  

Maintenance dose: 1.5 mg/kg IV/IM q8hr plus clindamycin IV or 3-5 mg/kg IV qDay

May initiate transition from parenteral to oral therapy of either oral doxycycline or oral clindamycin within 24-48 hr of clinical improvement for total treatment duration of 14 days

Plague (Yersinia pestis) Treatment (Off-label)

5 mg/kg IV/IM qDay for 10 days or 2 mg/kg IV/IM loading dose; then 1.7 mg/kg/dose IV/IM q8hr for 10-14 days or until 2 days after patient is afebrile; doxycycline, ciprofloxacin, or chloramphenicol could be used as third-line alternatives  

Dosage Modifications

Renal impairment

  • Conventional dosing
    • Renally adjusted dose recomendations are based on doses of 1.7 mg/kg/dose q8hr or 5-7 mg/kg/dose once daily  
    • CrCl>50 mL/min: No dosage adjustment necessary
    • CrCl 10-50 mL/min: Administer q12-48 hr
    • CrCl<10 mL/min: Administer q48-72 hr
  • Once daily (interval adjustment of extended interval dosing)
    • Adjust doses based on serum concentrations and organism MIC
    • CrCl≥60mL/min: No dosage adjustment necessary
    • CrCl 40-59 mL/min: 5-7 mg/kg IV q36hr  
    • CrCl 20-39 mL/min: 5-7 mg/kg IV q48hr
    • CrCl<20 mL/min: 5-7 mg/kg IV once; monitor serum levels and redose when gentamicin level is <1 mcg/mL
  • Intermittent hemodialysis
    • Administer after hemodialysis on dialysis days
    • Dependent on patients size, site of injection, filter, duration and type of intermittent hemodialysis, it is ~30-50% dialyzable
    • 1-1.7 mg/kg IV/IM after initial hemodialysis session; serum gentamicin concentrations should guide subsequent dosing  
    • Dosing dependent on assumption of 3 times/wk complete intermittent hemodialysis sessions
  • Peritoneal dialysis
    • Intermittent dosing: 0.6 mg/kg per exchange once daily for anuric patients; 0.75 mg/kg/dose IP for non-anuric patients qDay during long dwell periods; depending on infecting organism and patient's clinical status, may treat for 2-3 weeks  
    • Continuous dosing: 8 mg/L loading dose; followed by 4 mg/L maintenance dose
  • Continuous renal replacement therapy
    • Drug clearance is highly dependent on method of renal replacement, filter type, and flow rate; close monitoring of pharmacologic response, sign of adverse reactions due to accumulation, and target drug concentration necessary for appropriate dosing
    • 3 mg/kg/day IV/IM divided q8hr; may administer up to 5 mg/kg/day IV/IM divided q6-8hr in life-threatening infections; peak; adjust dose based on serum concentration monitoring; peak concentration >12 mcg/mL should be avoided  

Dosing Considerations

Gentamicin may be administered IV/IM

Infuse over 30-120 min when administering IV

Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as on the body space where distribution of the agent will occur

Monitor peak (4-12 mg/L) and trough (1-2 mg/L)

Monitor nephrotoxicity, neurotoxicity, and ototoxicity; assess at beginning of therapy and throughout

Each regimen must be followed by at least trough level drawn on third or fourth dose, 30 min before dosing unless renal toxicity suspected

May draw peak level 30 min after 30-min infusion has been completed or 1 hr after IM injection

Use ideal body weight for mg/kg/dose; more accurate than total body weight

Gentamicin is usually a first-line aminoglycoside against infections with gram-negative organisms such as Pseudomonas aeruginosa, Proteus, Escherichia coli, Klebsiella, Enterobacter, Serratia, and Citrobacter, as well as against Staphylococcus (gram- positive)

Bacterial organisms causing susceptible infections

  • Susceptible infections include the following:
  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)
  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)

Mycobacterium Infection (Orphan)

Gentamicin liposome injection: For disseminated Mycobacterium avium-intracellulare infection

Orphan indication sponsor

  • Liposome Company, Inc; One Research Way; Princeton, NJ 08540

Dosage Forms & Strengths

injectable solution

  • 10mg/mL
  • 40mg/mL

Intravenous solution

  • Intravenous solution
  • 60mg (50mL)
  • 70mg (50mL)
  • 80mg (50mL, 100mL)
  • 90mg (100mL)
  • 100mg (50mL, 100mL)
  • 120mg (100mL)

Susceptible Infections

Use of ideal body weight (IBW) for determining the mg/kg/dose appears to be more accurate than on the basis of total body weight (TBW)

Infants: 2.5 mg/kg/dose IV/IM q8hr

Children and adolescents:: 2-2.5 mg/kg/dose IV/IM q8hr  

<30 weeks' gestation

  • 0-28 days: 2.5 mg/kg/day IV/IM  
  • >28 days: 3 mg/kg/day IV/IM

30-36 weeks' gestation

  • 0-14 days: 3 mg/kg/day IV/IM  
  • >14 days: 5 mg/kg/day IV/IM divided q12hr

>36 weeks' gestation

  • 0-7 days: 5 mg/kg/day IV/IM divided q12hr  
  • >7 days: 7.5 mg/kg/day IV/IM divided q8hr

Surgical Prophylaxis, Preoperative (Off-label use)

2.5 mg/kg IV/IM within 60 min piror to surgical incision or without antibiotics; procedure dependent  

Dose is based on actual body weight unless >20% above ideal body weight; then dosage requirement may best be estimated using a dosing weight of IBW + 0.4 (TBW- IBW)

Dosage Modifications

GFR>50 mL/min/1.73m²: No dosage adjustment necessary

GFR 30-50 mL/min/1.73m²: Administer q12-18hr

GFR 10-29 mL/min/1.73m²: Administer q18-24hr

GFR <10 mL/min/1.73m² Administer q48-72hr

Intermitent hemodialysis: 2 mg/kg/dose; redose as indicated by serum concentration

Peritoneal dialysis: 2 mg/kg/dose; redose as indicated by serum concentration

Continuous renal replacement therapy: 2-2.5 mg/kg/dose q12-24hr; monitor serum concentration  

Dosing Considerations

Monitor peak (4-12 mg/L) and trough (1-2 mg/L)

Monitor nephrotoxicity, neurotoxicity, and ototoxicity; assess at beginning of therapy and throughout

Individualization critical due to low therapeutic index

Use ideal body weight for mg/kg/dose, except in neonates (in whom actual body weight should be used)

Bacterial organisms causing susceptible infections

  • Pseudomonas aeruginosa
  • Proteus species (indole-positive and indole-negative)
  • Escherichia coli
  • Klebsiella-Enterobacter-Serratia species
  • Citrobacter species
  • Staphylococcus species (coagulase-positive and coagulase-negative)
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Interactions

Interaction Checker

and gentamicin

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              Serious - Use Alternative (23)

              • agalsidase alfa

                gentamicin decreases effects of agalsidase alfa by pharmacodynamic antagonism. Contraindicated.

              • agalsidase beta

                gentamicin decreases effects of agalsidase beta by pharmacodynamic antagonism. Contraindicated.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • atracurium

                gentamicin increases effects of atracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • bacitracin

                gentamicin and bacitracin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug. Avoid concurrent use of bacitracin with other nephrotoxic drugs

              • BCG vaccine live

                gentamicin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • bumetanide

                bumetanide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • cholera vaccine

                gentamicin, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

              • cidofovir

                cidofovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • cisatracurium

                gentamicin increases effects of cisatracurium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • ethacrynic acid

                ethacrynic acid, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • furosemide

                furosemide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • incobotulinumtoxinA

                gentamicin increases effects of incobotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • neomycin PO

                gentamicin and neomycin PO both increase nephrotoxicity and/or ototoxicity. Avoid or Use Alternate Drug.

              • onabotulinumtoxinA

                gentamicin increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • pancuronium

                gentamicin increases effects of pancuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • quinidine

                quinidine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • rapacuronium

                gentamicin increases effects of rapacuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • rocuronium

                gentamicin increases effects of rocuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • succinylcholine

                gentamicin increases effects of succinylcholine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              • torsemide

                torsemide, gentamicin. Either increases toxicity of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of ototoxicity and nephrotoxicity.

              • typhoid vaccine live

                gentamicin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

              • vecuronium

                gentamicin increases effects of vecuronium by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of apnea.

              Monitor Closely (160)

              • abobotulinumtoxinA

                gentamicin increases effects of abobotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • acebutolol

                acebutolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aceclofenac

                aceclofenac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • acemetacin

                acemetacin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • acyclovir

                acyclovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • albuterol

                albuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • amikacin

                amikacin and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • amiloride

                amiloride increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • amiodarone

                amiodarone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • arformoterol

                arformoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • aspirin

                aspirin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • aspirin rectal

                aspirin rectal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • atenolol

                atenolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bazedoxifene/conjugated estrogens

                gentamicin will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • bendroflumethiazide

                bendroflumethiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • betaxolol

                betaxolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bisoprolol

                bisoprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bumetanide

                bumetanide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • candesartan

                candesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • capreomycin

                capreomycin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • carbenoxolone

                carbenoxolone and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • carboplatin

                carboplatin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • carvedilol

                carvedilol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • celecoxib

                celecoxib increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • celiprolol

                celiprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • cephaloridine

                cephaloridine and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • chlorothiazide

                chlorothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • chlorthalidone

                chlorthalidone and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • cisplatin

                cisplatin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • clarithromycin

                clarithromycin will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • clotrimazole

                clotrimazole will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • colistin

                colistin and gentamicin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • conjugated estrogens

                gentamicin will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • contrast media (iodinated)

                contrast media (iodinated) and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • cyclopenthiazide

                cyclopenthiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • cyclosporine

                cyclosporine and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • deferasirox

                deferasirox, gentamicin. Other (see comment). Use Caution/Monitor. Comment: Acute renal failure has been reported during treatment with deferasirox. Coadministration of deferasirox with other potentially nephrotoxic drugs, including aminoglycosides, may increase the risk of this toxicity. Monitor serum creatinine and/or creatinine clearance in patients who are receiving deferasirox and nephrotoxic drugs concomitantly.

              • deflazacort

                gentamicin and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • dichlorphenamide

                dichlorphenamide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • diclofenac

                diclofenac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dienogest/estradiol valerate

                gentamicin will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.

              • diflunisal

                diflunisal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • digoxin

                gentamicin will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

                digoxin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dobutamine

                dobutamine and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • dopexamine

                dopexamine and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • dronedarone

                dronedarone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • drospirenone

                drospirenone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                gentamicin and elvitegravir/cobicistat/emtricitabine/tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • ephedrine

                ephedrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • epinephrine

                epinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • epinephrine racemic

                epinephrine racemic and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • eprosartan

                eprosartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • erythromycin base

                erythromycin base will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                erythromycin ethylsuccinate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin lactobionate

                erythromycin lactobionate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • erythromycin stearate

                erythromycin stearate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • esmolol

                esmolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • estradiol

                gentamicin will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estrogens conjugated synthetic

                gentamicin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • estropipate

                gentamicin will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • ethacrynic acid

                ethacrynic acid and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • etodolac

                etodolac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • felodipine

                felodipine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • fenoprofen

                fenoprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • flurbiprofen

                flurbiprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • formoterol

                formoterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • fosphenytoin

                fosphenytoin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • furosemide

                furosemide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • hydrochlorothiazide

                hydrochlorothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • ibuprofen

                ibuprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen IV

                ibuprofen IV increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. NSAIDs may decrease excretion of aminoglycosides; data only on premature infants.

                ibuprofen IV increases levels of gentamicin by decreasing renal clearance. Use Caution/Monitor. Interaction mainly occurs in preterm infants.

              • indapamide

                indapamide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • indinavir

                indinavir will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • indomethacin

                indomethacin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ioversol

                ioversol and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • irbesartan

                irbesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • isoproterenol

                isoproterenol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • ketoconazole

                ketoconazole will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ketoprofen

                ketoprofen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ketorolac

                ketorolac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ketorolac intranasal

                ketorolac intranasal increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • labetalol

                labetalol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • levalbuterol

                levalbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • loratadine

                loratadine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • lornoxicam

                lornoxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • losartan

                losartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • magnesium supplement

                magnesium supplement, gentamicin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Each enhance the neuromuscular blocking effect of the other; may have negative respiratory effects.

              • meclofenamate

                meclofenamate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mefenamic acid

                mefenamic acid increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • meloxicam

                meloxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • mestranol

                gentamicin will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor.

              • metaproterenol

                metaproterenol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • methyclothiazide

                methyclothiazide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • metolazone

                metolazone and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • metoprolol

                metoprolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nabumetone

                nabumetone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nadolol

                nadolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • naproxen

                naproxen increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nebivolol

                nebivolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • nefazodone

                nefazodone will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nicardipine

                nicardipine will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nifedipine

                nifedipine will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • nilotinib

                nilotinib will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • norepinephrine

                norepinephrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • olmesartan

                olmesartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • oxaliplatin

                gentamicin and oxaliplatin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • oxaprozin

                oxaprozin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • parecoxib

                parecoxib increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • penbutolol

                penbutolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • peramivir

                gentamicin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • phenobarbital

                phenobarbital will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • phenytoin

                phenytoin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • pindolol

                pindolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • pirbuterol

                pirbuterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • piroxicam

                piroxicam increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • polymyxin B

                gentamicin and polymyxin B both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • potassium acid phosphate

                potassium acid phosphate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • potassium chloride

                potassium chloride increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • potassium citrate

                potassium citrate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • prabotulinumtoxinA

                gentamicin increases effects of prabotulinumtoxinA by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • propranolol

                propranolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • quercetin

                quercetin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rifampin

                rifampin will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • rimabotulinumtoxinB

                gentamicin, rimabotulinumtoxinB. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Aminoglycosides may enhance botulinum toxin effects. Closely monitor for increased neuromuscular blockade.

              • ritonavir

                ritonavir will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sacubitril/valsartan

                sacubitril/valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • salicylates (non-asa)

                salicylates (non-asa) increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • salmeterol

                salmeterol and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • salsalate

                salsalate increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sirolimus

                sirolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • sodium picosulfate/magnesium oxide/anhydrous citric acid

                gentamicin decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of gentamicin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of gentamicin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

                gentamicin and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • sotalol

                sotalol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • spironolactone

                spironolactone increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • St John's Wort

                St John's Wort will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • streptozocin

                gentamicin and streptozocin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • succinylcholine

                succinylcholine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sulfasalazine

                sulfasalazine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • sulindac

                sulindac increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tacrolimus

                tacrolimus will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                gentamicin and tacrolimus both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • teicoplanin

                gentamicin and teicoplanin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.

              • telmisartan

                telmisartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tenofovir DF

                gentamicin and tenofovir DF both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

                gentamicin increases levels of tenofovir DF by decreasing elimination. Use Caution/Monitor.

              • terbutaline

                terbutaline and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • timolol

                timolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tobramycin

                gentamicin and tobramycin both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor.

              • tobramycin inhaled

                tobramycin inhaled and gentamicin both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

              • tolfenamic acid

                tolfenamic acid increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolmetin

                tolmetin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • tolvaptan

                tolvaptan will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

                tolvaptan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • torsemide

                torsemide and gentamicin both decrease serum potassium. Use Caution/Monitor.

              • trazodone

                trazodone will decrease the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • triamterene

                triamterene increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

              • trimagnesium citrate anhydrous

                gentamicin, trimagnesium citrate anhydrous. Either increases effects of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration of aminoglycosides with magnesium may increase risk of neuromuscular weakness and paralysis.

              • valsartan

                valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • verapamil

                verapamil will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              Minor (72)

              • aceclofenac

                aceclofenac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • acemetacin

                acemetacin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • adefovir

                adefovir and gentamicin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • aspirin

                aspirin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aspirin rectal

                aspirin rectal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • aztreonam

                aztreonam, gentamicin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Combination may be used synergistically against Pseudomonas spp. and Enterobacteriaceae.

              • balsalazide

                gentamicin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • biotin

                gentamicin will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium acetate

                gentamicin decreases levels of calcium acetate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium carbonate

                gentamicin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium chloride

                gentamicin decreases levels of calcium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium citrate

                gentamicin decreases levels of calcium citrate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • calcium gluconate

                gentamicin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • celecoxib

                celecoxib increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • clotrimazole

                clotrimazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • cordyceps

                cordyceps decreases toxicity of gentamicin by unspecified interaction mechanism. Minor/Significance Unknown.

              • cyanocobalamin

                gentamicin decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              • cytarabine

                cytarabine decreases effects of gentamicin by unspecified interaction mechanism. Minor/Significance Unknown.

              • diclofenac

                diclofenac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • diflunisal

                diflunisal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • entecavir

                gentamicin, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

              • etodolac

                etodolac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • fenoprofen

                fenoprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • fluconazole

                fluconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • flurbiprofen

                flurbiprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • foscarnet

                foscarnet and gentamicin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • ibuprofen

                ibuprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • indomethacin

                indomethacin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketoconazole

                ketoconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • ketoprofen

                ketoprofen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketorolac

                ketorolac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • ketorolac intranasal

                ketorolac intranasal increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • lornoxicam

                lornoxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • magnesium chloride

                gentamicin decreases levels of magnesium chloride by increasing renal clearance. Minor/Significance Unknown.

              • magnesium citrate

                gentamicin decreases levels of magnesium citrate by increasing renal clearance. Minor/Significance Unknown.

              • magnesium hydroxide

                gentamicin decreases levels of magnesium hydroxide by increasing renal clearance. Minor/Significance Unknown.

              • magnesium oxide

                gentamicin decreases levels of magnesium oxide by increasing renal clearance. Minor/Significance Unknown.

              • magnesium sulfate

                gentamicin decreases levels of magnesium sulfate by increasing renal clearance. Minor/Significance Unknown.

              • meclizine

                meclizine, gentamicin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Ototoxicity of aminoglycoside may be masked.

              • meclofenamate

                meclofenamate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • mefenamic acid

                mefenamic acid increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • meloxicam

                meloxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • methoxyflurane

                gentamicin and methoxyflurane both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • miconazole vaginal

                miconazole vaginal decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • nabumetone

                nabumetone increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • naproxen

                naproxen increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • noni juice

                noni juice increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

              • oxaprozin

                oxaprozin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • pantothenic acid

                gentamicin will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • parecoxib

                parecoxib increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • paromomycin

                gentamicin and paromomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • pentamidine

                gentamicin and pentamidine both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • perindopril

                perindopril, gentamicin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Mfr. recommends using combination with caution (interaction not specified).

              • piperacillin

                piperacillin increases effects of gentamicin by pharmacodynamic synergism. Minor/Significance Unknown.

              • piroxicam

                piroxicam increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • posaconazole

                posaconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • pyridoxine

                gentamicin will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • pyridoxine (Antidote)

                gentamicin will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • salsalate

                salsalate increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • streptomycin

                gentamicin and streptomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • sulindac

                sulindac increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • thiamine

                gentamicin will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.

              • ticarcillin

                ticarcillin decreases effects of gentamicin by altering metabolism. Minor/Significance Unknown. Increased risk in renal impairment.

              • tolfenamic acid

                tolfenamic acid increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • tolmetin

                tolmetin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.

              • vancomycin

                gentamicin and vancomycin both increase nephrotoxicity and/or ototoxicity. Minor/Significance Unknown.

              • voriconazole

                voriconazole decreases levels of gentamicin by unknown mechanism. Minor/Significance Unknown.

              • zoledronic acid

                gentamicin, zoledronic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive hypocalcemia.

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              Adverse Effects

              >10%

              Neurotoxicity (vertigo, ataxia)

              Gait instability

              Ototoxicity (auditory, vestibular)

              Nephrotoxicity (decreased CrCl)

              Nephrotoxicity if trough >2 mg/L

              1-10%

              Edema

              Rash

              Reddening of skin

              Itching

              <1%

              Drowsiness

              Headache

              Pseudomotor cerebri

              Photosensitivity

              Allergic reaction

              Erythema

              Anorexia

              Nausea/vomiting

              Weight loss

              Increased salivation

              Enterocolitis

              Granulocytopenia

              Agranulocytosis

              Thrombocytopenia

              Elevated LFTs

              Burning

              Stinging

              Tremors

              Muscle cramps

              Weakness

              Dyspnea

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              Warnings

              Black Box Warnings

              Patients treated with aminoglycosides should be under close clinical observation due to potential toxicity associated with their use

              Neurotoxicity, manifested as bilateral auditory and vestibular ototoxicity, can occur in patients with preexisting renal impairment and in patients with normal renal function treated at higher doses and/or for periods longer than those recommended; high-frequency deafness usually occurs first and can be detected only with audiometric testing

              Aminoglycosides are potentially nephrotoxic; risk is greater in patients with impaired renal function and in those who receive high doses or prolonged therapy; rarely, nephrotoxicity may not become apparent until the first few days after cessation of therapy

              Use with caution in premature infants and neonates because of renal immaturity and the resulting prolongation of serum half-life of the drug

              Monitor eighth cranial nerve and renal function; especially in patients with known or suspected reduced renal function at onset of therapy and also in patients with normal function at the beginning of therpay but that develop signs of rena dysfunction during therapy; examine urine for increased excretion of protein, decreased specific gravity and presence of cells; serial audiograms should be obtained when possible; adjust the dose or discontinue therapy if there is evidence of ototoxicity or nephrtoxicity

              Neuromuscular blockade and respiratory paralysis have been reported following parenteral injection, topical instillation (as in orthopedic and abdominal irrigation or in local treatment of empyema), and oral use of aminoglycosides, especially when given soon after anesthesia or muscle relaxants; if blockage occurs, calcium salts may reverse these phenomena, but mechanical respiratory assistance may be necessary

              Avoid concurrent or sequential use of neurotoxic and/or nephrotoxic drugs, including other aminoglycosides (eg, amikacin, streptomycin, neomycin, kanamycin, paromomycin)

              Cumulative listing of drugs to avoid from all aminoglycosides; package inserts includes amphotericin B, bacitracin, cephaloridine, cisplatin, colistin, polymyxin B, vancomycin, and viomycin

              Avoid potent diuretics (eg, ethacrynic acid, furosemide) because they increase risk of ototoxicity; when administered intravenously, diuretics may enhance aminoglycoside toxicity by altering antibiotic concentrations in serum and tissue

              Contraindications

              Prior aminoglycoside toxicity or hypersensitivity

              Cautions

              Patients treated withaminoglycosides should be under close clinical observation; high risk of toxicity associated with their use

              Risk of ototoxicity; tinnitus or vertigo may be indications of vestibular injury and impending bilateral irreversible damage; discontinue therapy if signs of ototoxicity occur

              Risk of nephrotoxicity; other factors that increase patient risk of ototoxicity include advanced age and dehydration

              Narrow therapeutic index (not intended for long-term therapy)

              Caution in renal failure (not on dialysis), myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission

              Adjust dose in renal impairment

              Endocarditis prophylaxis (GI, GU procedure): AHA Guidelines recommend only for high-risk patients

              Diuretics may enhance aminoglycoside toxicity by altering antibiotic concentration in serum and tissue; certain diuretics by themselves may cause ototoxicity; avoid potent diuretics, including ethacrynic acid or furosemide

              Use caution in patients with electrolyte abnormalitie including hypocalcemia, hypomagnesemia, or hypokelemia

              Use caution in patients with neuromuscular disorders, including myasthenia gravis

              Use caution in patients with hearing and renal impairment

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              Pregnancy & Lactation

              Pregnancy category: D

              Lactation: Enters breast milk; use with caution (AAP Committee states "compatible with nursing")

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Aminoglycoside antibiotic for coverage of gram-negative bacteria, including Pseudomonas species; synergistic with beta lactamase against enterococci; interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits

              Absorption

              Peak plasma time: IM (30-90 min); IV (30 min after 30-min infusion)

              Distribution

              Gentamicin crosses placenta; relative diffusion from blood into CSF is minimal even with inflammation

              CSF-to-blood level ratio: Normal meninges (minimal); inflamed meninges (10-30%)

              Protein bound: <30%

              Vd: Neonates (0.4-0.6 L/kg); children: (0.3-0.35 L/kg); adults: (0.2-0.3 L/kg); Vd increased by edema, ascites, and fluid overload and decreased by dehydration

              Elimination

              Half-life: 2-3 hr (NRF)

              Renal clearance: Directly related to renal function

              Excretion: Urine (70% recovered as unchanged drug in patients with NRF)

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              Administration

              IV Incompatibilities

              Additive: Ampho B, ampicillin, cefazolin, dopamine, furosemide, heparin

              Syringe: Ampicillin, heparin

              Y-site: Furosemide, heparin

              Not spec: Carbenicillin

              IV Compatibilities

              Additive: cimetidine, clindamycin, verapamil

              Syringe: clindamycin

              Y-site: Amiodarone, esmolol, vitamins B/C

              IV Preparation

              Dilute single dose in 50-200 mL NS or D5W

              IV Administration

              Infuse over 30 min-2 hr

              After infusion, flush line with NS or D5W

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Gentak ophthalmic (eye)
              -
              0.3 % (3 mg/gram) ointment
              gentamicin ophthalmic (eye)
              -
              0.3 % drops
              gentamicin ophthalmic (eye)
              -
              0.3 % drops
              gentamicin ophthalmic (eye)
              -
              0.3 % drops
              gentamicin ophthalmic (eye)
              -
              0.3 % drops
              gentamicin injection
              -
              40 mg/mL vial
              gentamicin injection
              -
              40 mg/mL vial
              gentamicin injection
              -
              20 mg/2 mL vial
              gentamicin injection
              -
              40 mg/mL vial
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % cream
              gentamicin topical
              -
              0.1 % cream
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % cream
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % cream
              gentamicin topical
              -
              0.1 % ointment
              gentamicin topical
              -
              0.1 % cream
              gentamicin topical
              -
              0.1 % cream

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              gentamicin ophthalmic (eye)

              GENTAMICIN OINTMENT - OPHTHALMIC

              (jen-ta-MYE-sin)

              COMMON BRAND NAME(S): Garamycin

              USES: This medication is used to treat bacterial infections (such as blepharitis, conjunctivitis) of the eye and the skin around the eyes (such as eyelids). It is also used to prevent infection after eye injury or surgery. It belongs to a class of drugs known as aminoglycoside antibiotics. Gentamicin works by killing the bacteria.This medication treats only bacterial eye infections. It will not work for other types of eye infections. Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.This drug should not be used in newborns due to an increased risk of serious side effects.

              HOW TO USE: To apply eye ointment, wash your hands first. To avoid contamination, be careful not to touch the tip of the tube or let it touch your eye, eyelid, or any other surface. Apply to the eyes only. Do not swallow or inject.Do not wear contact lenses while you are using this medication. Sterilize contact lenses according to the manufacturer's directions, and check with your doctor before you begin using them again.To apply eye ointments, tilt your head back, look up, and gently pull down the lower eyelid to make a pouch. Place a half-inch (1.3 centimeters) strip of ointment into the pouch as directed by your doctor. Gently close the eye and roll the eyeball in all directions to spread the medication. Try not to blink and do not rub the eye. Repeat these steps for your other eye if so directed. Wipe the tip of the ointment tube with a clean tissue to remove extra medication before recapping it. Wait several minutes for your vision to clear before driving or operating machinery.The dosage is based on your medical condition and response to treatment. Your doctor may direct you to use this medication more often at first, then use it less frequently as the infection improves. Do not increase your dose or use it more often than directed. Your doctor may prescribe gentamicin drops for use during the day and gentamicin ointment at bedtime.If you are using another kind of eye medication (such as drops or ointments), wait at least 5 minutes before applying other medications. Use eye drops before eye ointments to allow the drops to enter the eye.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Continue using it for the full time prescribed. Stopping the medication too soon may allow the bacteria to continue to grow, which may result in a return of the infection.Tell your doctor if your condition persists or worsens.

              SIDE EFFECTS: Eye stinging/burning/redness or temporary blurred vision may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Use of this medication for prolonged or repeated periods may result in other types of eye infections, including fungal infections. Stop using this medication and contact your doctor if you notice new or worsening eye symptoms (such as pain, swelling, thick discharge or pus).Rarely, gentamicin products used in the eye may be absorbed and may cause serious side effects. Tell your doctor right away if any of these rare but serious side effects occur: easy bruising/bleeding, mental/mood changes (such as hallucinations).A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before using gentamicin, tell your doctor or pharmacist if you are allergic to it; or to other aminoglycoside antibiotics (such as tobramycin); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: contact lens use.After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or do any activity that requires clear vision until you are sure you can perform such activities safely.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This drug may pass into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

              OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Do not share this medication with others.This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor tells you to.

              MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised April 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.